Background

The optimal management of localized gallbladder perforation (Neimeier type II) has yet to be defined. The aim of this systematic review was to identify factors associated with improved patient outcomes.

Methods

Systematic review of studies that described the management of Neimeier type II perforation, reported complications of the first intervention, necessity of added interventions, resolution of the pathology, and days of hospital stay were included. The search strategy was conducted in EMBASE, Mayo Journals, MEDLINE, SCOPUS, and Web of Science (December 2020)

Results

A total of 122 patients (53% male) from case reports, series, and cohorts were included for analysis. In total 56 (46%) and 44 (36%)patients were treated with open and laparoscopic cholecystectomy respectively. Overall risk of bias was moderate. The need for another intervention was higher in the laparoscopic group (5 vs 17, p=<0.001) as well as prevalence of complications (4 vs 16, p=<0.001), but lower for days of hospital stay (median days 5. vs 15, p = 0.008) against open cholecystectomy. Preoperative percutaneous catheter drainage did not influence outcome.

Conclusion

Open cholecystectomy has a lower need for further surgical procedures and postoperative complications, but a longer hospital stay. These outcomes did not vary with preoperative percutaneous drainage. The effect of timing of cholecystectomy did not influence the outcomes.

中文翻译：

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局限性胆囊穿孔：治疗和预后的系统评价

背景

局部胆囊穿孔（Neimeier II 型）的最佳治疗尚未确定。本系统评价的目的是确定与改善患者预后相关的因素。

方法

包括对描述 Nemeier II 型穿孔管理、首次干预并发症报告、增加干预的必要性、病理学解决和住院天数的研究的系统评价。检索策略在 EMBASE、Mayo Journals、MEDLINE、SCOPUS 和 Web of Science 中进行（2020 年 12 月）

结果

共有来自病例报告、系列和队列的 122 名患者（53% 男性）被纳入分析。共有 56 例（46%）和 44 例（36%）患者分别接受了开腹和腹腔镜胆囊切除术。总体偏倚风险为中等。腹腔镜组对另一种干预的需求较高（5 vs 17，p=<0.001）以及并发症的发生率（4 vs 16，p=<0.001），但住院天数较低（中位天数为5.001）。 vs 15, p = 0.008) 反对开腹胆囊切除术。术前经皮导管引流不影响结果。

结论

开腹胆囊切除术对进一步外科手术和术后并发症的需求较低，但住院时间较长。这些结果不随术前经皮引流而变化。胆囊切除术时机的影响不影响结果。